by Dr. Patricia Thompson
Originally published on 23 August 2014 by the Bonnie J. Addario Lung Cancer Foundation
As a medical oncologist, I treat patients battling a variety of cancers – from common types such as breast and prostate to rare cancers of the brain and bones. But of all the types of cancer I see, none causes patients as much fear and dread as lung cancer.
Such distress is understandable. The disease continues to be the leading cause of cancer death for both men and women in the U.S. More people die of lung cancer each year than the next three most common types of cancer – breast, colon and pancreatic – combined. According to the American Cancer Society (ACA), lung cancer is expected to claim the lives of nearly 160,000 Americans in 2014, accounting for 27 percent of all U.S. cancer deaths.
Another reason lung cancer is feared is that long-term survival rates are very low. Although five-year survival is more than 53 percent for cases detected when the disease is still localized (within the lungs), it drops to less than 4 percent when diagnosed after tumors have spread to other organs. Unfortunately, because lung cancer can be difficult to detect, only 15 percent of cases are diagnosed at an early stage.
Although lung cancer rates are falling overall, the rate has been increasing among two groups in particular: women and non-smokers. In fact, according to the National Cancer Institute, over the past 36 years the rate of new lung cancer cases among men has dropped by nearly a quarter, while the rate among women has risen 100 percent. The U.S. Centers for Disease Control and Prevention reports that more women die of lung cancer than breast, uterine and ovarian cancers combined.
Another notable trend is the increase in lung cancer among healthy non-smokers. The ACA reports that between 16,000 and 24,000 Americans who have never smoked die from lung cancer every year. If lung cancer in non-smokers were its own category, it would rank among the top 10 fatal cancers in the U.S. For reasons doctors don’t fully understand, most lung cancer cases among non-smokers occur in women.
The rise in lung cancer among non-smokers is one reason stigmatizing the disease is increasingly seen as inappropriate. While it’s true the majority of cases continue to be diagnosed among smokers or former smokers, lung cancer can also result from factors over which individuals have little control: genetic mutations, as well as exposure to radon gas, secondhand smoke, air pollution and asbestos, among others.
Much more important is to continue improving our methods of detection and treatment. Great progress is being made in both. For example, while chest X-rays are generally the first diagnostic imaging a patient might undergo when lung cancer is suspected, low-dose computed tomography (CT) scans are proving more effective at finding lung tumors earlier, when they are easier to treat.
The value of CT scans in early lung cancer detection is making such screening more common. Some medical organizations are now recommending routine lung screening for high-risk patients – defined as individuals 55 to 74 years old with at least a 30-year smoking history, and who currently smoke or quit within the past 15 years. These are also the patients that derive the most benefit from screening.
For patients diagnosed with lung cancer, advances in treatment options are offering more hope. In addition to new surgical techniques which no longer require full open-lung surgery, technological advances are making radiation therapy more precise than ever – targeting lung tumors and sparing healthy tissue. With brachytherapy, thin catheters carry radioactive ‘seeds’ to lung tumors to deliver high doses of radiation up close.
Chemotherapy is advancing too, with new drugs and medical technologies that can help increase lung cancer survival. One exciting development is immunotherapy, which uses antibodies and man-made proteins to bolster the immune system and train it to attack cancer cells. Ongoing research on human genes is also helping scientists develop therapies specifically targeting the genetic mutations that drive tumor growth.
What’s most important to remember about lung cancer is it’s largely preventable, but everyone has some risk. Given recent trends, women should be aware of the signs of lung cancer – a lingering or worsening cough, shortness of breath, chest pain, unexplained weight loss, hoarseness, among others – and not hesitate to seek medical care if concerned. Let’s raise awareness of this terrible disease because awareness helps find a cure.
The following was originally published at DukeHealth.org by Dr. Thomas A. D’Amico on June 21st, 2011. Thomas A. D’Amico, MD, is a professor of surgery and director of the Duke Cancer Institute’s lung cancer program. He was elected chair of the National Comprehensive Cancer Network board of directors in 2010.
Lung Cancer: Is “The Blame Game” Hurting our Progress? Thomas A. D'Amico, MD
As a thoracic surgeon, I operate on lung cancer patients every day. We discuss life-and-death issues regarding their surgeries, but we don’t usually talk about how they feel about their disease.
At a recent lung cancer advocacy event, I had the opportunity to hear one of my patients tell her story. A former Division I soccer player for East Carolina University, 24-year-old Taylor Bell was diagnosed with lung cancer two weeks after her 21st birthday. She puts a very different face on lung cancer than most people expect.
She’s very grateful for her survival, but she says that, even when she’s talking to survivors of other types of cancer -- to anyone, really -- when she tells people she has had lung cancer, inevitably everyone asks the same thing: “Did you smoke?”
Her point of view is, “Why is that the most important thing you want to know about me?” It’s offensive to her because, number one, she didn’t smoke, and number two, what if she did? Would that mean that she deserved the disease?
Assigning Blame for Lung Cancer
That is the underlying assumption when many people think about lung cancer: In an international survey commissioned in 2010 by the Global Lung Cancer Coalition, 22 percent of U.S. respondents admitted they feel less sympathy for lung cancer patients than for patients with other types of cancer, because of the link to smoking.
The reality is that 15 to 20 percent of folks who get lung cancer have no personal firsthand experience with tobacco. Some, like Taylor Bell, are complete non-smokers. Some have been exposed to secondhand smoke, which certainly is not their fault.
If you counted just deaths from lung cancer among nonsmokers, lung cancer would still be the sixth leading cause of cancer-related deaths in the United States.
But no one should be blamed for getting cancer, regardless of their smoking history. Most smokers first start the habit as teenagers, and by adulthood it becomes entrenched; nicotine addiction is among the hardest to overcome.
The real issue is not the smoker who develops cancer; it’s how we as a society assign blame for disease. If we are to measure our sympathies for the ill by the behaviors that may have contributed to their illness, what about the patients with debilitating heart disease who have led high-stress, low-exercise lifestyles, or people with type 2 diabetes who had poor eating habits?
What about the smokers who didn’t develop lung cancer but developed breast cancer, heart disease, or stroke?
Would you have more sympathy for a smoker with lung cancer if you knew he had grown up with little education about the dangers of smoking?
What about if the individual had a strong genetic predisposition to nicotine addiction?
Stigma Slows Progress in Fight Against Lung Cancer
The truth is, it’s rare that we can draw a straight line from a person’s disease to their lifestyle choices, and applying moral judgments to the ill is not only a waste of energy, but also a slippery moral slope.
I believe the public-health campaign against smoking and tobacco use has had unintended consequences: not only stigma for the victims of diseases associated with smoking, but actually slowing our progress in the fight against those diseases. And that is something we need to pay attention to.
The fact is that lung cancer is the most important cancer disease in our country, and indeed among all developed countries, in terms of its impact. In 2010, lung cancer caused 157,300 deaths in the United States, more than breast, prostate, and colon cancer combined, according to estimates from the American Cancer Society.
In 2006, the most recent year for which we have estimates, we spent $10.3 billion in care for lung cancer patients, and the estimated loss of economic productivity due to lung cancer is $36.1 billion -- far higher than the next-highest figure (which is breast cancer, at a $12.1-billion loss).
The burden of this disease to us as a society should be, in itself, enough to compel us to do everything we can to improve diagnosis and treatment. Yet lung cancer receives much less research funding than other types of cancer that cause fewer deaths.
The stigma associated with lung cancer definitely takes its toll on survivors personally, and it’s possible that it also affects research funding for the disease. Using the most recent available data on National Cancer Institute research funding, lung cancer received only $1,875 per death, compared to $17,028 per breast cancer death, $10,638 per prostate cancer death, and $6,008 per colorectal cancer death.
It’s impossible to read the minds of people who make decisions regarding funding for lung cancer research, but I think funding disparities can be attributed partly to a combination of the smoking stigma and ageism. If a 73-year-old person has a life-threatening disease, that’s not perceived as being as important to society as a disease that affects younger people. And an older patient population also means less patient advocacy.
The fight against breast cancer, for example, has been promoted successfully because many young women who are survivors have their life to give to raising awareness. The cure rate for lung cancer is much lower than for breast cancer. So there are fewer advocates.
Need for New Screening Methods and Biologic Therapies
There is a need for greater research funding to advance two priorities that could make a significant difference for patients with lung cancer -- perfection of screening methods to catch more cases in the early stages, and stepped-up evaluation of biologic therapies, which can be equally as effective or more effective than chemotherapy without the overall toxicity.
Improved screening is an urgent need. Today, only about 20 percent of lung-cancer cases are caught at stage one. If we could increase that to 40 percent, we would improve survival dramatically.
Spiral computed tomography (CT) scan screening is a promising technique that’s being tested for patients known to be at high risk, but as a widespread tool, even CT has a drawback: the high chance of false positives.
Your CT scan might show a little nodule, but that does not necessarily mean you have lung cancer, and follow-up testing for lung cancer is invasive: if you have a positive screening for a mammography, you get a needle biopsy, but a positive screen from a CT scan might lead to a surgery.
We would like to be able to determine your true cancer status without having to do additional CT screens on you for the next five years or subjecting you to an unnecessary lung biopsy.
A line of research that holds much promise is perfecting a method for combining CT scans with a serum or urine test that detects a protein or other biomarker.
Even if we improve diagnosis, we’ll always have people who present with advanced disease, and the cure rate for those people is, frankly, dismal. One way to improve that rate is with better targeting of biologic therapies.
Industry is producing these agents faster than we can test them. We need to put more effort into testing and enhancing these agents -- which could improve treatment for others cancers as well. For instance, Avastin (bevacizumab) is now known to be successful against lung cancer, but it wasn’t originally conceived as a lung cancer agent.
To carry out these research priorities, we must erase the stigma that accompanies lung cancer and give the disease the full research support that its sufferers and their families deserve.
In the meantime, we will count on survivors such as Taylor Bell, who handles the smoking question with grace. After she tells people that no, she never smoked, the second question usually is: “Well, how did you get it?” Her response: “Why does anyone get cancer?”
The following was originally published at dailylocal.com on Monday, March 11th, 2013 by Dr. Alicia McKelvey. Dr. McKelvey is a thoracic surgeon on staff at Paoli Hospital in Chester County, PA.
Lung cancer is the leading cause of cancer death in the US. In fact, more people die of lung cancer than of colon, breast and prostate cancers combined.
Screening for colon, breast and prostate cancer have played a significant role in reducing the number of deaths due to these diseases. Until recently, however, no screening test for lung cancer has proven effective in detecting the disease at an early, more treatable stage.
In August 2011, the National Lung Screening Trial, sponsored by the National Cancer Institute, released findings from the first scientific study of an effective screening technique using advanced imaging technology called the low dose helical CT scan (LDHCT) that significantly reduces death due to lung cancer in high risk individuals.
This study demonstrated 20 percent fewer lung cancer deaths in those who underwent screening with LDHCT as compared with those who were screened with standard chest x-rays. High risk individuals are those who are 55 to 74 years old and who have a 30 or more pack year smoking history and former smokers who quit within the last 15 years. Pack years is a term used to categorize smoking history and is calculated by the number of packs smoked each day times the years of smoking.
Screening with the low-dose CT scan enabled the detection of lung cancer at its earliest stage when there are typically no symptoms to indicate a problem. Early stage lung cancer means the disease has not spread to other organs or to lymph nodes.
Knowing the stage along with other factors, including the type of cancer and the patient’s overall health, helps doctors to recommend the best treatment. Treatment options for lung cancer include surgery, radiation, chemotherapy or any combination of these therapies. The typical course for early stage lung cancer is surgery to remove the diseased tissue.
If concerned about lung cancer, contact a physician to discuss ways to reduce the risk and whether screening with a LDHCT is beneficial.
@bonniejaddario Responds to @consumerreports March Issue Cover Story #lungcancer #earlydetection #factsRead Now
Leading magazine downplays value of lung cancer screenings, to the detriment of advances in early detection research.
SAN CARLOS, Calif., March 20, 2013 /PRNewswire
The following statement was issued by Bonnie J. Addario regarding the March cover article in Consumer Reports: The cancer tests you need--and those you don't:
"I am appalled by the March 2013 Consumer Reports cover story (The cancer tests you need--and those you don't), because of the misleading and misguided message it sends to people who really need life-saving cancer screening tests, and how it discredits the value and importance of proper early detention cancer screening tests.
"The article's irresponsible reporting is best summed up in this statement on page 31: 'But most people shouldn't waste their time on screenings for bladder, lung, oral, ovarian, prostate, pancreatic, skin or testicular cancers.'
"Consumer Reports is one of the most trusted publications in America. Anyone, whether they know they are low or high risk, will read that statement and walk away believing early detection cancer screening tests are unnecessary. The six-page article mentions only twice that its ratings apply only to asymptomatic, low-risk population.
"Shame on Consumer Reports. We are talking about people's lives here.
"I myself am a lung cancer survivor. For more than a year I was misdiagnosed and not given an early detection screening test, even though I was in a high-risk category. When I was finally diagnosed I was stage 3B. Unlike so many others, I beat the odds. But my odds would have been better with an early detection cancer screening test. I founded the Bonnie J. Addario Lung Cancer Foundation seven years ago to advocate and raise money for better research, education, early detection and treatment. Because something must be done.
The stats are staggering.
"Cancer screening and treatment are certainly at a crossroads, as the article states. This is made clear as well by recent legislation to direct more tobacco settlement money to early lung cancer detection programs. But the article's irresponsible representation of the value of screening tests, I fear, might damage the progress my lung cancer foundation has made over the past seven years - just as we are making great strides.
"People cannot readily see symptoms of lung cancer. Symptoms are deep in the lungs, unlike breast cancer, where lumps can be felt and are visible. When you are diagnosed with lung cancer it is often at stage four, when it's too late.
"The Consumer Reports article makes only one responsible and thoughtful statement: 'Weighing the risks and benefits of cancer screening is best done in the context of a patient-doctor relationship.'
"Consumer Reports should stay out of the health care advice business, and stick to writing about toasters and washing machines. I wouldn't approach my doctor about whether I should buy a Honda or a Ford. And likewise, people should not consult Consumer Reports to help them decide whether or not to have a potentially life-saving cancer screening test."
About the Bonnie J. Addario Lung Cancer Foundation
The Bonnie J. Addario Lung Cancer Foundation is one of the largest philanthropies (patient-founded, patient-focused, and patient-driven) devoted exclusively to eradicating Lung Cancer through research, early detection, education, and treatment. The Foundation works with a diverse group of physicians, organizations, industry partners, individuals, survivors, and their families to identify solutions and make timely and meaningful change. BJALCF was established on March 6, 2006 as a 501c(3) non-profit organization and has raised more than $9 million for lung cancer research.
This article was originally published at About.com on January 10th, 2013 by Lynne Eldridge, MD.
Studies have shown that when it comes to breast cancer, older women are more likely to be diagnosed with advanced stages of the disease.
Not so with lung cancer - at least in recent studies in Denmark and England. Instead, it seems the slogan reads "early age later stage."
Researchers in Denmark set out to evaluate the stage of lung cancer at which different age groups are diagnosed. Looking at people aged 65-69, those aged 70 to 74 were 18% less likely to be diagnosed with late stage disease. The trend continued on: Those aged 75 to 79 were 26% less likely, 80 to 84 were 27% less likely, and those over 85, 34% less likely to have a diagnosis of late disease. Since the stage at diagnosis makes a tremendous difference in long-term survival from lung cancer, this is something to stand up and take note of.
Why would younger people be less likely to diagnosed with lung cancer until it's reached the later stages of the disease? Or to ask the question in another way: Why does age seem to have a protective effect against late stage lung cancer diagnosis? Possibilities shared with me by Georogios Lyratzopoulous MD, one of the investigators in another study in England demonstating "early age later stage" include:
The conclusion based on these findings is that efforts to diagnose lung cancer early need to be tailored to different age groups. The stage of a lung cancer at the time of diagnosis can have a huge impact on younger patients with lung cancer. In the study above from Denmark, only 17% of the cancers were diagnosed at stage 1 and stage 2. To tailor the diagnostic process for different age groups, we need to focus on more diagnostic research instead of just treatment research.
An Actuarial Analysis Shows That Offering Lung Cancer Screening As An Insurance Benefit Would Save Lives At Relatively Low CostRead Now
Help Get the Lung Cancer Mortality Reduction Act Passed! Contact your Senators and Representative Today!Read Now
The Joan Gaeta Lung Cancer Fund advocate Jackie Archer is traveling to Washington DC by invitation to speak with Congressmen, Senators, and others about the need for the early detection of lung cancer. A lung cancer survivor herself, Jackie's cancer was detected early by accident - literally. It took a head-on car crash and a trip to the emergency room for doctors to discover her tumor early enough. Each year, nearly 160,000 lung cancer patients are not so "lucky". Jackie will be taking the time in DC to network with anyone and everyone to help make a difference. Thanks, Jackie!
One thing that YOU can do is to contact every Senator and Congressman from your great state and ask them to support the Lung Cancer Mortality Reduction Act (HR 1394).
Below is a list of co-sponsors in the Senate and the House that have already agreed to support the Lung Cancer Mortality Reduction Act. As you can see, we need additional sponsors!
This article was originally published on January 26th, 2012 in Concordiensis, the student newspaper of Union College in Schenectady, New York by Jessica Doran.
“Smoking kills.” It’s a typical phrase that has been ingrained in the minds of young and old people alike to denote that smoking causes lung cancer. This is very true, but it also causes people to be ignorant as to how lung cancer can affect even those who do not smoke, have never smoked or never even touched a cigarette. This is the case of Tonya Martinez-Hilton, who passed away in December after a battle with lung cancer.
Lung cancer kills 160,000 people a year, and what many do not realize is that these are more lives lost than due to breast, pancreatic and colon cancer. However, the quality of care for lung cancer patients is affected because of the smoking stigma. Smoking is the leading cause of lung cancer, but shortly behind it in causes are radon exposure and genetics. Radon accumulation in a house that rises above a certain level can reek havoc on a persons lungs without them even knowing.
The quality of care that is given to lung cancer patients suffers because it is assumed that they have done this to themselves. But even the effects of secondhand smoke from the previous generations can have damaging repercussions on anyone who comes into its path.
The bottom line is that lung cancer is very rarely caught and stopped in the early stages. It is often not detected until the later stages, when the tumor can have metastasized into a problem that is extremely difficult to eradicate because it has spread to other parts of the body.
Mike Hilton, Tonya’s husband, has made it a personal quest to not only extensively research everything about lung cancer, but to make it a goal that screening and proceedings for detecting the disease are found promptly.
“My wife had a history of lung cancer, but no doctor ever asked her about it or made an effort to get anything checked out,” he said. Chest x-rays alone can detect only large masses, so by the time that is caught, the tumor has probably metastasized. Hilton hopes that CT scans become part of protocol for medical proceedings so that tumors are found early.
Hilton is involved with the Bonnie Addario Lung Cancer Foundation, based in California. They focus on fundraising and grants, and have their own medical research facility. He is their East Coast representative, and has already looked into instituting a program of early lung cancer screenings at Ellis Hospital.
“If we even had one program in Schenectady County, a test run of an early screening program, we could see how the numbers of lung cancers survivors would rise. Visible change could help us to spread the program,” he said.
The foundation is also putting pressure on legislature, particularly the Lung Cancer Mortality Reduction Act, a bill that has not yet been passed but which serves to provide better guidance to medical professionals.
If this money is allocated properly, more funds can be used to support new-age treatments that have shown promise in recent years. Among these, there is new, targeted chemotherapy that affects the receptors within the tumor itself to stop it from growing. In addition to other drugs and vaccines that has been shown to increase life expectancy up to 44 months. Many of these are in the later stages of FDA approval.
However, above all, the future of lung cancer treatment lies in early detection and in stage one diagnosis. Hilton made it clear that he is hoping to see lung cancer treated as a manageable disease within the next few years.
This is where he petitions to the Union community. There are many people on this campus involved in the pre-medical field, with a commitment to achieving true change.
“If they go into the medical field, this is what they need to focus on,” Hilton said. “Your generation are the minds of the future who are going to put horrible diseases like cancer to rest for good.”